From theory to action: Implementing the WSSD Global Initiative on children's environmental health indicators
Setting priorities for children's environmental health indicators
Environmental threats to children’s health include a broad range of hazards of different natures (e.g. physical, chemical, biological), in different media (e.g. water, air, food, soil), in different settings (e.g. home, school, community), and in relation to different activities (e.g. playing, working). One of the main purposes of children’s environmental health indicators is to help display time trends in and spatial distributions of those environmental threats that matter most to children’s health, and to define and motivate the appropriate policy response and interventions to reduce these threats (Box 2). Moreover, children’s environmental health indicators can also play a crucial role in identifying especially vulnerable population groups, such as children living in urban slums.
Box 2
Children’s environmental health indicators help to fill the gap between information on environment and information on health, putting into focus the special vulnerabilities of children in order to guide environmental, health, and development policy. Consequently, useful children’s environmental health indicators must be both relevant to the decision-maker and, directly or indirectly, amenable to control5. By analogy, children’s environmental health indicators can be likened to economic indicators – such as gross domestic product or the unemployment rate – that give a sense of how well the economy is doing6.
Why children’s environmental health indicators?
At the global level, the recent WHO publication “Making a difference: indicators to improve children’s environmental health” sets priorities in terms of an analysis of the global burden of disease, as measured in disability-adjusted life years (DALYs)7 8. Five major causes of death and illness in children under five emerge, with environmental exposures making a significant contribution to all of them:
- Perinatal illnesses – including low birthweight, stillbirths and congenital anomalies;
- Respiratory diseases – including pneumonia, tuberculosis, and asthma;
- Diarrhoeal diseases – including rotavirus infections, E.coli infections and cholera;
- Vector-borne diseases – especially malaria;
- Physical injuries – including traffic accidents, poisonings, drowning, falls and burns.
These five “big killers” of children under five have thus formed the focus for indicator development at the global level. However, environmental threats differ significantly among various regions of the world and even among various countries within a given region: while traditional risks such as unsafe drinking water, lack of adequate sanitation and indoor air pollution from household solid fuel use and environmental tobacco smoke prevail in developing countries, industrialized and developing countries alike face a multitude of modern and emerging risks including environmental allergens, toxic chemicals and exposures in relation to recreational and work activities, e.g. exposure to ultraviolet radiation. As developing countries still carry the major share of the global burden of disease (1 351 million DALYs or 92.1% of the world total), the global priorities are ultimately determined by the environmental threats in developing countries.
Given the broad range of environmental threats to children's health and national data collection systems that are already overburdened, regions and countries will need to determine their own priorities with respect to key issues of concern and selected key children’s environmental health indicators. These priorities are likely to be very different between developing and more developed regions of the world. The results of a regional or national environmental burden of disease assessment represent one way of prioritizing; however, prioritizing based on settings, public concern, previous political decisions, available interventions to tackle specific environmental problems, or financial and staff resources may be equally justified approaches. In any case, the ultimate goal is to protect children’s health. Whichever approach a region or country decides to take, it is important to make the underlying rationale for setting priorities transparent.